Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2011

Open Access 01-12-2011 | Research article

Study of recent and future trends in place of death in Belgium using death certificate data: a shift from hospitals to care homes

Authors: Dirk Houttekier, Joachim Cohen, Johan Surkyn, Luc Deliens

Published in: BMC Public Health | Issue 1/2011

Login to get access

Abstract

Background

Since most patients prefer out-of-hospital death, place of death can be considered an indicator of end-of-life care quality. The study of trends in place of death is necessary to examine causes of shifts, to evaluate efforts to alter place of death and develop future policies. This study aims to examine past trends and future projections of place of death.

Methods

Analysis of death certificates (decedents aged ≥ 1 year) in Belgium (Flanders and Brussels Capital region) 1998-2007. Trends in place of death were adjusted for cause of death, sociodemographic characteristics, environmental factors, numbers of hospital beds, and residential and skilled nursing beds in care homes. Future trends were based on age- and sex-specific mortality prognoses.

Results

Hospital deaths decreased from 55.1% to 51.7% and care home deaths rose from 18.3% to 22.6%. The percentage of home deaths remained stable. The odds of dying in a care home versus hospital increased steadily and was 1.65 (95%CI:1.53-1.78) in 2007 compared to 1998. This increase could be attributed to the replacement of residential beds by skilled nursing beds. Continuation of these trends would result in the more than doubling of deaths in care homes and a decrease in deaths at home and in hospital by 2040.

Conclusions

Additional end-of-life care resources in care homes largely explain the decrease in hospital deaths. Care homes will become the main locus of end-of-life care in the future. Governments should provide sufficient skilled nursing resources in care homes to fulfil the end-of-life care preferences and needs of patients.
Appendix
Available only for authorised users
Literature
1.
Gott M, Seymour J, Bellamy G, Clark D, Ahmedzai S: Older people's views about home as a place of care at the end of life. Palliat Med. 2004, 18: 460-467. 10.1191/0269216304pm889oa.CrossRefPubMed
2.
Wolff JL, Kasper JD, Shore AD: Long-term care preferences among older adults: a moving target?. J Aging Soc Policy. 2008, 20: 182-200. 10.1080/08959420801977574.CrossRefPubMed
3.
Lo JC: The impact of hospices on health care expenditures-the case of Taiwan. Soc Sci Med. 2002, 54: 981-991. 10.1016/S0277-9536(01)00071-5.CrossRefPubMed
4.
Chappell NL, Dlitt BH, Hollander MJ, Miller JA, McWilliam C: Comparative costs of home care and residential care. Gerontologist. 2004, 44: 389-400.CrossRefPubMed
5.
Houttekier D, Cohen J, Bilsen J, Deboosere P, Verduyckt P, Deliens L: Determinants of the place of death in the Brussels metropolitan region. J Pain Symptom Manage. 2009, 37: 996-1005. 10.1016/j.jpainsymman.2008.05.014.CrossRefPubMed
6.
Cohen J, Bilsen J, Hooft P, Deboosere P, van der Wal G, Deliens L: Dying at home or in an institution using death certificates to explore the factors associated with place of death. Health Policy. 2006, 78: 319-329. 10.1016/j.healthpol.2005.11.003.CrossRefPubMed
7.
Cohen J, Houttekier D, Onwuteaka-Philipsen B, Miccinesi G, Addington-Hall J, Kaasa S, et al: Which patients with cancer die at home? A study of six European countries using death certificate data. J Clin Oncol. 2010, 28: 2267-2273. 10.1200/JCO.2009.23.2850.CrossRefPubMed
8.
9.
10.
Centeno C, Clark D, Lynch T, Racafort J, Praill D, De Lima L, et al: Facts and indicators on palliative care development in 52 countries of the WHO European region: results of an EAPC Task Force. Palliat Med. 2007, 21: 463-471. 10.1177/0269216307081942.CrossRefPubMed
11.
Davies E, Linklater KM, Jack RH, Clark L, Moller H: How is place of death from cancer changing and what affects it? Analysis of cancer registration and service data. Br J Cancer. 2006, 95: 593-600. 10.1038/sj.bjc.6603305.CrossRefPubMedPubMedCentral
12.
Neutel CI, Bishop ML, Harper SD, Gaudette LA: Proportion of cancer deaths occurring in hospital, Canada, 1994-2000. Can J Public Health. 2005, 96: 264-268.PubMed
13.
Hunt RW, Fazekas BS, Luke CG, Roder DM: Where patients with cancer die in South Australia, 1990-1999: a population-based review. Med J Aust. 2001, 175: 526-529.PubMed
14.
Higginson IJ, Astin P, Dolan S: Where do cancer patients die? Ten-year trends in the place of death of cancer patients in England. Palliat Med. 1998, 12: 353-363. 10.1191/026921698672530176.CrossRefPubMed
15.
Hunt R, Bonett A, Roder D: Trends in the terminal care of cancer patients: South Australia, 1981-1990. Aust N Z J Med. 1993, 23: 245-251.CrossRefPubMed
16.
van der Velden L, Francke AL, Hingstman L, Willems DL: Dying from cancer or other chronic diseases in the Netherlands: ten-year trends derived from death certificate data. BMC Palliat Care. 2009, 8: 4-10.1186/1472-684X-8-4.CrossRefPubMedPubMedCentral
17.
Wilson DM, Truman CD, Thomas R, Fainsinger R, Kovacs-Burns K, Froggatt K, et al: The rapidly changing location of death in Canada, 1994-2004. Soc Sci Med. 2009, 68: 1752-1758. 10.1016/j.socscimed.2009.03.006.CrossRefPubMed
18.
Gomes B, Higginson IJ: Where people die (1974-2030): past trends, future projections and implications for care. Palliat Med. 2008, 22: 33-41. 10.1177/0269216307084606.CrossRefPubMed
19.
20.
Ahmad S, O'Mahony MS: Where older people die: a retrospective population-based study. QJM. 2005, 98: 865-870. 10.1093/qjmed/hci138.CrossRefPubMed
21.
Flory J, Yinong YX, Gurol I, Levinsky N, Ash A, Emanuel E: Place of death: U.S. trends since 1980. Health Aff (Millwood ). 2004, 23: 194-200. 10.1377/hlthaff.23.3.194.CrossRef
22.
Wilson DM, Northcott HC, Truman CD, Smith SL, Anderson MC, Fainsinger RL, et al: Location of death in Canada. A comparison of 20th-century hospital and nonhospital locations of death and corresponding population trends. Eval Health Prof. 2001, 24: 385-403. 10.1177/01632780122034975.CrossRefPubMed
23.
Brameld KJ, Holman CD, Bass AJ, Codde JP, Rouse IL: Hospitalisation of the elderly during the last year of life: an application of record linkage in Western Australia 1985-1994. J Epidemiol Community Health. 1998, 52: 740-744. 10.1136/jech.52.11.740.CrossRefPubMedPubMedCentral
24.
Clark D, ten Have H, Janssens R: Common threads? Palliative care service developments in seven European countries. Palliat Med. 2000, 14: 479-490. 10.1191/026921600701536408.CrossRefPubMed
25.
26.
Van Hecke E: Developing a policy instrument to manage the programming, planning and implementationof care and welfare facilities. [In Dutch]. 2001, Leuven: K.U.Leuven Institute for Social and Economic Geography
27.
Federal Planning Bureau Directorate of Statistics and Economic Information. Population Projections 2007-2060 [In Dutch]. 2008, Brussels: Federal Planning Bureau Directorate of Statistics and Economic Information
28.
Gomes B, Higginson IJ: Factors influencing death at home in terminally ill patients with cancer: systematic review. BMJ. 2006, 332: 515-521. 10.1136/bmj.38740.614954.55.CrossRefPubMedPubMedCentral
29.
Tang ST, McCorkle R: Determinants of place of death for terminal cancer patients. Cancer Invest. 2001, 19: 165-180. 10.1081/CNV-100000151.CrossRefPubMed
30.
Hunt RW, Bond MJ, Groth RK, King PM: Place of death in South Australia. Patterns from 1910 to 1987. Med J Aust. 1991, 155: 549-553.PubMed
31.
Wilson DM, Smith SL, Anderson MC, Northcott HC, Fainsinger RL, Stingl MJ, et al: Twentieth-century social and health-care influences on location of death in Canada. Can J Nurs Res. 2002, 34: 141-161.PubMed
32.
33.
Van den Block L, Deschepper R, Bilsen J, Van Casteren V, Deliens L: Transitions between care settings at the end of life in belgium. JAMA. 2007, 298: 1638-1639. 10.1001/jama.298.14.1638.CrossRefPubMed
34.
Menec VH, Nowicki S, Blandford A, Veselyuk D: Hospitalizations at the end of life among long-term care residents. J Gerontol A Biol Sci Med Sci. 2009, 64: 395-402. 10.1093/gerona/gln034.CrossRefPubMed
35.
De Gendt C, Bilsen J, Vander Stichele R, Deliens L: Nursing home policies regarding advance care planning in Flanders, Belgium. Eur J Public Health. 2010, 20: 189-194. 10.1093/eurpub/ckp121.CrossRefPubMed
36.
Teno JM: Now is the time to embrace nursing homes as a place of care for dying persons. J Palliat Med. 2003, 6: 293-296. 10.1089/109662103764978614.CrossRefPubMed
37.
Brazil K, Krueger P, Bedard M, Kelley L, McAiney C, Justice C, et al: Quality of care for residents dying in Ontario long-term care facilities: findings from a survey of directors of care. J Palliat Care. 2006, 22: 18-25.PubMed
38.
Brazil K, Bedard M, Krueger P, Taniguchi A, Kelley ML, McAiney C, et al: Barriers to providing palliative care in long-term care facilities. Can Fam Physician. 2006, 52: 472-473.PubMedPubMedCentral
Metadata
Title
Study of recent and future trends in place of death in Belgium using death certificate data: a shift from hospitals to care homes
Authors
Dirk Houttekier
Joachim Cohen
Johan Surkyn
Luc Deliens
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2011
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-11-228

Other articles of this Issue 1/2011

BMC Public Health 1/2011 Go to the issue

Research article

Measuring adherence to antiretroviral therapy in northern Tanzania: feasibility and acceptability of the Medication Event Monitoring System

Research article

The influence of population characteristics on variation in general practice based morbidity estimations

Research article

Associations between characteristics of the home food environment and fruit and vegetable intake in preschool children: A cross-sectional study

Study protocol

Rationale, design and methods for a randomised and controlled trial of the impact of virtual reality games on motor competence, physical activity, and mental health in children with developmental coordination disorder

Study protocol

Effect of an office worksite-based yoga program on heart rate variability: A randomized controlled trial

Research article

Needle and syringe programs in Yunnan, China yield health and financial return